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  • Producer Information Form/Contract Request

  • Welcome to the Producer Information Form/Contract Request. In just a few short steps you will be providing UNI Health Coverage Agency, LLC DBA UNI Medicare and Health Insurance Agency with the information we need to get your contracting to you. Once delivered, we will follow up to help you along in the process. Thanks!

  • Appointment Type Definitions

    Individual: Commission paid direct to the agent

    Corporation: Agent contracting as an Agency/Corporation and assigning commission to the Agency/Corporation. This selection is for AGENCY PRINCIPALS ONLY

    Solicitor (LOA): Agent employed by upline and assigning commission to the upline

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  • Carrier Contract Request Selection

  • NOTE: Anthem requires your Social Security Number to initiate the contract. A member of our Onboarding Team will call you to obtain in order to send the contract invitation. You may also call us directly at 678-887-7102.

  • Contact us with any questions: 678-887-7102

  • For UNI Medicare and Health Insurance Agency Use Only

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